Stroke is one of the leading causes of long-term adult disability, affecting approximately 795,000 people each year in the U.S. The very word “stroke” indicates that no one is ever prepared for this sudden, often catastrophic event. Stroke survivors and their families can find workable solutions to most difficult situations by approaching every problem with patience, ingenuity, perseverance and creativity. Early recovery and rehabilitation can improve functions and sometimes remarkable recoveries for someone who suffered a stroke

After a serious injury, illness or surgery, you may recover slowly. You may need to regain your strength, relearn skills or find new ways of doing things you did before. This process is rehabilitation.

Rehabilitation often focuses on

Physical therapy to help your strength, mobility and fitness

Occupational therapy to help you with your daily activities

Speech-language therapy to help with speaking, understanding, reading, writing and swallowing

Treatment of pain

The type of therapy and goals of therapy may be different for different people. An older person who has had a stroke may simply want rehabilitation to be able to dress or bathe without help. A younger person who has had a heart attack may go through cardiac rehabilitation to try to return to work and normal activities. Someone with a lung disease may get pulmonary rehabilitation to be able to breathe better and improve their quality of life.

Physical therapists (PTs) are highly-educated, licensed health care professionals who can help patients reduce pain and improve or restore mobility – in many cases without expensive surgery and often reducing the need for long-term use of prescription medications and their side effects.

Physical therapists can teach patients how to prevent or manage their condition so that they will achieve long-term health benefits. PTs examine each individual and develop a plan, using treatment techniques to promote the ability to move, reduce pain, restore function, and prevent disability. In addition, PTs work with individuals to prevent the loss of mobility before it occurs by developing fitness- and wellness-oriented programs for healthier and more active lifestyles.

Physical therapists provide care for people in a variety of settings, including hospitals, private practices, outpatient clinics, home health agencies, schools, sports and fitness facilities, work settings, and nursing homes. State licensure is required in each state in which a physical therapist practices.

Cognitive rehabilitation therapy

Cognitive rehabilitation is a program to help brain-injured or otherwise cognitively impaired individuals to restore normal functioning, or to compensate for cognitive deficits.[1] It entails an individualized program of specific skills training and practice plus metacognitive strategies. Metacognitive strategies include helping the patient increase self-awareness regarding problem-solving skills by learning how to monitor the effectiveness of these skills and self-correct when necessary.

Cognitive rehabilitation therapy (offered by a trained therapist) is a subset of Cognitive Rehabilitation (community-based rehabilitation, often in traumatic brain injury; provided by rehabilitation professionals) and has been shown to be effective for individuals who suffered a stroke in the left or right hemisphere.[2] or brain trauma.[3] A computer-assisted type of cognitive rehabilitation therapy called cognitive remediation therapy has been used to treat schizophrenia, ADHD, and major depressive disorder.[4][5][6][7][8]

It may also be recommended for traumatic brain injury, the primary population for which it was developed in the university medical and rehabiltation communities,[11][12][13][14] such as that suffered by U.S. Representative Gabrielle Giffords, according to Dr. Gregory J. O’Shanick of the Brain Injury Association of America.[15] Her new doctor has confirmed that it will be part of her rehabilitation.[16] Cognitive rehabilitation may be part of a comprehensive community services program and integrated into residential services, such as supported living, supported employment, family support, professional education, home health (as personal assistance),[17][18] recreation, or education programs in the community.

Assessments

Individuals and families respond differently to different interventions, in different ways, at different times after injury. Premorbid functioning, personality, social support, and environmental demands are but a few of the factors that can profoundly influence outcome. In this variable response to treatment, cognitive rehabilitation is no different from treatment for cancer, diabetes, heart disease, Parkinson’s disease, spinal cord injury, psychiatric disorders, or any other injury or disease process for which variable response to different treatments is the norm.

Nevertheless, many different statistical analyses of the benefits of this therapy have been carried out. One study made in 2002 analyzed 47 treatment comparisons and reported “a differential benefit in favor of cognitive rehabilitation in 37 of 47 (78.7%) comparisons, with no comparison demonstrating a benefit in favor of the alternative treatment condition.”[2]

An internal study conducted by the Tricare Management Agency in 2009 is cited by the US Department of Defense as its reason for refusing to pay for this therapy for veterans who have suffered traumatic brain injury. According to Tricare, “There is insufficient, evidence-based research available to conclude that cognitive rehabilitation therapy is beneficial in treating traumatic brain injury.”[20] The ECRI Institute, whose report serves as the basis for this decision by the Department of Defense, has summed up their own findings this way:[1]

In our report, we carried out several meta-analyses using data from 18 randomized controlled trials. Based on data from these studies, we were able to conclude the following:

Adults with moderate to severe traumatic brain injury who receive social skills training perform significantly better on measures of social communication than patients who receive no treatment.

Adults with traumatic brain injury who receive comprehensive cognitive rehabilitation therapy report significant improvement on measures of quality of life compared to patients who receive a less intense form of therapy.

The strength of the evidence supporting our conclusions was low due to the small number of studies that addressed the outcomes of interest. Further, the evidence was too weak to draw any definitive conclusions about the effectiveness of cognitive rehabilitation therapy for treating deficits related to the following cognitive areas: attention, memory, visuospacial skills, and executive function. The following factors contributed to the weakness of the evidence: differences in the outcomes assessed in the studies, differences in the types of cognitive rehabilitation therapy methods/strategies employed across studies, differences in the control conditions, and/or insufficient number of studies addressing an outcome.

Citing this 2009 assessment, US Department of Defense, one of the federal agencies not responsible for health care decisions in the US, has declared that cognitive rehabilitation therapy is scientifically unproved and should refer their concerns to the US Department of Health and Human Services, US Budget and Management, and/or the Government Accountability Office (GAO). As a result, it refuses to cover the cost of cognitive rehabilitation for brain-injured veterans.[20][21] Cost-benefit and cost-effectiveness studies, together with an analysis of personnel and veterans’ services for new our emerging groups in head and brain injuries, are recommended.

Soderback I.; Ekholm J. (1992). “January–March). Medical and social factors affecting behavior patterns in patients with acquired brain damage: a study of patients living at home three years after incident”. Disability and Rehabilitation. 14 (1): 30–35. doi:10.3109/09638289209166424.

Vestibular Rehabilitation Therapy (VRT)

Evidence has shown that vestibular rehabilitation can be effective in improving symptoms related to many vestibular (inner ear/balance) disorders.1,2 People with vestibular disorders often experience problems with vertigo, dizziness, visual disturbance, and/or imbalance. These are the problems that rehabilitation aims to address. Other problems can also arise that are secondary to vestibular disorders, such as nausea and/or vomiting, reduced ability to focus or concentrate, and fatigue.

Symptoms due to vestibular disorders can diminish quality of life and impact all aspects of daily living. They also contribute to emotional problems such as anxiety and depression. Additionally, one of the consequences of having a vestibular disorder is that symptoms frequently cause people to adopt a sedentary lifestyle in order to avoid bringing on, or worsening, dizziness and imbalance. As a result, decreased muscle strength and flexibility, increased joint stiffness, and reduced stamina can occur.

Treatment strategies used in rehabilitation can also be beneficial for these secondary problems.

WHAT IS VESTIBULAR REHABILITATION?

Vestibular rehabilitation (VR), or vestibular rehabilitation therapy (VRT) is a specialized form of therapy intended to alleviate both the primary and secondary problems caused by vestibular disorders. It is an exercise-based program primarily designed to reduce vertigo and dizziness, gaze instability, and/or imbalance and falls. For most people with a vestibular disorder the deficit is permanent because the amount of restoration of vestibular function is very small. However, after vestibular system damage, people can feel better and function can return through compensation. This occurs because the brain learns to use other senses (vision and somatosensory, i.e. body sense) to substitute for the deficient vestibular system. The health of particular parts of the nervous system (brainstem and cerebellum, visual, and somatosensory sensations) is important in determining the extent of recovery that can be gained through compensation.

For many, compensation occurs naturally over time, but for people whose symptoms do not reduce and who continue to have difficulty returning to daily activities, VRT can help with recovery by promoting compensation.3

The goal of VRT is to use a problem-oriented approach to promote compensation. This is achieved by customizing exercises to address each person’s specific problem(s). Therefore, before an exercise program can be designed, a comprehensive clinical examination is needed to identify problems related to the vestibular disorder. Depending on the vestibular-related problem(s) identified, three principal methods of exercise can be prescribed: 1) Habituation, 2) Gaze Stabilization, and/or 3) Balance Training.4

Habituation exercises are used to treat symptoms of dizziness that are produced because of self-motion3 and/or produced because of visual stimuli5,6. Habituation exercise is indicated for patients who report increased dizziness when they move around, especially when they make quick head movements, or when they change positions like when they bend over or look up to reach above their heads. Also, habituation exercise is appropriate for patients who report increased dizziness in visually stimulating environments, like shopping malls and grocery stores, when watching action movies or T.V., and/or when walking over patterned surfaces or shiny floors.

Habituation exercise is not suited for dizziness symptoms that are spontaneous in nature and do not worsen because of head motion or visual stimuli. The goal of habituation exercise is to reduce the dizziness through repeated exposure to specific movements or visual stimuli that provoke patients’ dizziness. These exercises are designed to mildly, or at the most moderately, provoke the patients’ symptoms of dizziness. The increase in symptoms should only be temporary, and before continuing onto other exercises or tasks the symptoms should return completely to the baseline level. Over time and with good compliance and perseverance, the intensity of the patient’s dizziness will decrease as the brain learns to ignore the abnormal signals it is receiving from the inner ear.

Gaze Stabilization exercises are used to improve control of eye movements so vision can be clear during head movement. These exercises are appropriate for patients who report problems seeing clearly because their visual world appears to bounce or jump around, such as when reading or when trying to identify objects in the environment, especially when moving about.

There are two types of eye and head exercises used to promote gaze stability. The choice of which exercise(s) to use depends on the type of vestibular disorder and extent of the disorder. One type of gaze stability exercise incorporates fixating on an object while patients repeatedly move their heads back and forth or up and down for up to a couple of minutes. The following pictures demonstrate examples of this type of gaze stability exercise.

The other type of gaze stability exercise is designed to use vision and somatosensation (body sense) as substitutes for the damaged vestibular system. Gaze shifting and remembered target exercises use sensory substitution to promote gaze stability. These exercises are particularly helpful for patients with poor to no vestibular function, such as patients with bilateral (both sides) inner ear damage.4

Balance Training exercises are used to improve steadiness so that daily activities for self-care, work, and leisure can be performed successfully. Exercises used to improve balance should be designed to address each patient’s specific underlying balance problem(s).7 Also, the exercises need to be moderately challenging but safe enough so patients do not fall while doing them. Features of the balance exercises that are manipulated to make them challenging, include:

Visual and/or somatosensory cues

Stationary positions and dynamic movements

Coordinated movement strategies (movements from ankles, hips, or a combination of both)

Dual tasks (performing a task while balancing)

Additionally, balance exercises should be designed to reduce environmental barriers and fall risk. For example, the exercises should help improve patients’ ability to walk outside on uneven ground or walk in the dark. Ultimately, balance training exercises are designed to help improve standing, bending, reaching, turning, walking, and if required, other more demanding activities like running, so that patients can safely and confidently return to their daily activities.

For patients with Benign Paroxysmal Positional Vertigo (BPPV) the exercise methods described above are not appropriate. First a clinician needs to identify the type of BPPV the patient is suffering from, and then different repositioning exercises can be performed.8,9 For more details about BPPV, including diagnosis and treatment, see VeDA’s article on this topic.

After BPPV has been successfully treated and spinning symptoms resolved, some patients will continue to report non-specific dizziness (symptoms other than spinning) and/or imbalance. In these cases, treatment using habituation exercise and/or balance training may be indicated.4

WHAT SHOULD PATIENTS EXPECT FROM VESTIBULAR REHABILITATION?

VRT is usually performed on an outpatient basis, although in some cases, the treatment can be initiated in the hospital. Patients are seen by a licensed physical or occupational therapist with advanced post-graduate training.

VRT begins with a comprehensive clinical assessment that should include collecting a detailed history of the patient’s symptoms and how these symptoms affect their daily activities. The therapist will document the type and intensity of symptoms and discuss the precipitating circumstances.

Additionally, information about medications, hearing or vision problems, other medical issues, history of falls, previous and current activity level, and the patient’s living situation will be gathered.

The assessment also includes administering different tests to more objectively evaluate the patient’s problems. The therapist will screen the visual and vestibular systems to observe how well eye movements are being controlled. Testing assesses sensation (which includes gathering information about pain), muscle strength, extremity and spine range of motion, coordination, posture, balance, and walking ability.

A customized exercise plan is developed from the findings of the clinical assessment, results from laboratory testing and imaging studies, and input from patients about their goals for rehabilitation. For example, a person with BPPV may undergo a canal repositioning exercise for the spinning s/he experiences, whereas, someone with gaze instability and dizziness due to vestibular neuritis (a deficit from a weakened inner ear) may be prescribed gaze stability and habituation exercises, and if the dizziness affects their balance this may also include balance exercises.

An important part of the VRT is to establish an exercise program that can be performed regularly at home. Compliance with the home exercise program is essential to help achieve rehabilitation and patient goals.

Along with exercise, patient and caregiver education is an integral part of VRT. Many patients find it useful to understand the science behind their vestibular problems, as well as how it relates to the difficulties they may have with functioning in everyday life. A therapist can also provide information about how to deal with these difficulties and discuss what can be expected from VRT. Education is important for patients because it takes away much of the mystery of what they are experiencing, which can help reduce anxiety that may occur as a result of their vestibular disorder.

ARE VESTIBULAR REHABILITATION EXERCISES DIFFICULT TO DO?

VRT exercises are not difficult to learn, but to achieve maximum success patients must be committed to doing them.

Since the exercises can sometimes be tedious, setting up a regular schedule so that the exercises can be incorporated into daily life is very important.

Exercises may, at first, make symptoms seem worse. But with time and consistent work, symptoms should steadily decrease, which means participation in activities of daily life will be easier for patients to do.

FACTORS THAT CAN IMPACT RECOVERY

When patients participate in VRT different factors can impact the potential for recovery. For example, the type of vestibular disorder affects recovery. Patients that have a stable vestibular disorder, such as vestibular neuritis or labyrinthitis, have the best opportunity to achive a satisfactory resolution of their symptoms. When patients have a progressive vestibular disorder, like multiple sclerosis, or a fluctuating condition, like migraine and Meniere’s, which cause spontaneous attacks of dizziness or vertigo, compensation can be difficult to achieve, and therefore, success with VRT is more difficult.

To improve the chance for success with VRT for patients with progressive or fluctuating disorders it is important to manage these disorders medically. Patients with vestibular migraine may benefit more from VRT by implementing behavioral changes (reduction of migraine triggers and participation in cognitive behavioral treatment) and/or using pharmacological therapy to help reduce or eliminate the headache attacks. Although VRT does not treat the attacks of vertigo that patients with Meniere’s disease experience, if the frequency of these attacks is reduced with diet and medication, or if indicated, with a more aggressive chemical or surgical type of intervention, then VRT can possibly help reduce symptoms that occur between attacks. The goal of medical management is to help stabilize the disorder as best as possible to allow for compensation to occur. As a consequence, the exercise strategies used in VRT will have a better chance to promote compensation and reduce vestibular-related symptoms.10,11,12,13

There are differences in potential recovery depending on the vestibular disorder. If patients have a unilateral lesion (only one ear affected by a vestibular disorder) they generally have a better chance of recovery as compared to those with bilateral lesions (both ears are affected). VRT does assist with recovery in patients with bilateral lesions, just not the same amount and not as quickly as in patients with unilateral lesions.14,15

For patients with central vestibular disorders, the structures of the brain that allow for compensation are affected. This limits the amount and speed of recovery. However, research has shown that patients with central vestibular disorders can make gains with VRT.3

Other factors that can potentially limit recovery:

Sedentary lifestyle

Being inactive can lead to suboptimal levels of health and fitness, which can cause secondary problems. Also, this lifestyle can further decrease the tolerance to movement by decreasing the threshold that it takes to aggravate the symptoms of dizziness and unsteadiness. In turn, desire to be active is reduced even more, thus creating a vicious cycle. Slowly and progressively, training the body to increase tolerance to movement and promote physical fitness is a goal of VRT and can address this factor.

Pain

In general, pain contributes to imbalance and is associated with increased risk of falls in older adults.16 People also restrict their movement and activity level to avoid pain, which leads to a more sedentary lifestyle and the negative consequences of this lifestyle. Additionally, to avoid pain patients may not be able to do the prescribed exercises, which restricts full participation in VRT and limits VRT’s effectiveness. For these reasons, pain should be routinely assessed and managed with physical therapy and medical interventions as needed so that results can be maximized.

Presence of Other Medical Conditions

It is more difficult to accomplish the goals set out in VRT when patients have to deal with multiple medical conditions. In fact, any condition that reduces the ability to perform the exercises will lessen the chances of achieving success. Additionally, just as pain is a factor that increases the risk of falling, certain medical conditions (cardiovascular, arthritis, foot problems, vision problems, neurological diseases, cognitive impairments) are also factors that increase fall risk.17 Assessment and proactive, comprehensive management of these conditions should be done.

Certain Medications and/or Multiple Medications

Use of medication is a “double edged sword” because on one side it provides needed benefits that are necessary for managing disease, but on the other hand it can cause side effects like dizziness, sedation, muscle fatigue and weakness, and unsteadiness and falls, which magnifies the problems that already exist due to the vestibular disorder. Additionally, when multiple medications are prescribed, the side effects are compounded. Tinetti and colleague’s work17 has revealed that not only is taking four or more medications a factor that increases a patient’s risk of falls, but also that certain types of medications like psychoactive medications (sedatives, antipsychotics, and antidepressants), anticonvulsants, and antihypertensive mediations are strongly associated with an increased risk of falling.

In particular, when it comes to medication usage for vestibular disorders, frequently patients are prescribed medication like meclizine (Antivert) and diazepam (Valium) for acute symptoms. The goal of these medicines is to act on the brain so that the intensity of dizziness and/or nausea is not as strong. Because these medications suppress brain function they can be counter-productive with promoting compensation, so it is best to not use them for extended periods of time.3

Since there can be a tradeoff between the benefits and risks of using medications, decisions about usage should be made on an individual basis and should include the priorities of each patient. For instance, certain medications that reduce blood pressure can cause lightheadedness, which can potentially lead to unsteadiness and/or falls. Determining which is more important, the risk of heart disease and stroke or the risk of falling and therefore causing injury, causes a dilemma in patient management. Physicians take into consideration which patients are at greater risk of having a stroke – in which case it would be in their best interest to control their blood pressure – as compared to patients who are at more risk of falling, in which case taking medication that lowers blood pressure too much may not be indicated.

Patients can be helpful with making decisions about medication usage by knowing what their medications are supposed do for them and understanding the possible side effects. This can lead to more effective discussions between patients and physicians about symptoms that might be experienced from as a result of taking a particular medication. From these conversations, physicians can work toward achieving the intended benefit of the medication while minimizing potential side effects by taking different actions:

Make sure medications are being taken correctly

Adjust medication dosage

Eliminate unnecessary medications

Prescribe a different medication

Emotional Concerns

Anxiety, panic, and depression occur frequently with vestibular disorders and can cause difficulty with managing symptoms.

Frequently, patients will restrict their activity to avoid increasing their vestibular related symptoms. While this coping strategy may reduce the anxiety a patient experiences as a result of their symptoms, it limits compensation that is necessary to promote recovery.

With slow, progressive exposure to movement and activity patients can experience improvement in their vestibular symptoms, which help reduce their anxiety. However, for many patients, it may be helpful to seek counseling to deal with the difficult emotional challenges that often accompany life with a chronic illness. Cognitive behavioral and/or pharmacological therapy can help address a patient’s underlying anxiety so they can achieve the goals of VRT.18,19

Decompensation

With compensation, vestibular symptoms will decrease as the brain recalibrates and fine tunes incoming signals from the inner ear. However, when damage to the vestibular system is permanent there is the potential for symptoms to return.

Symptomatic relapses can occasionally occur because the brain de-compensates. This can be due to different emotional and/or physical stressors, like personal or job-related pressures, periods of inactivity, a bad cold or flu, extreme fatigue or chronic lack of sleep, changes in medication, or sometimes surgery.3 Although it is important for patients to consult with their physician to make sure nothing new has occurred, returning to the exercises that promoted the initial compensation can help promote recovery again. Additionally, recovery after de-compensation usually occurs more quickly as compared to the initial compensation.

Where can I find a vestibular rehabilitation specialist?

The Vestibular Disorders Association (VeDA) provides a directory of health professionals who are specially trained to assess and treat vestibular disorders. This online directory offers users the ability to search for providers according to specialty and geographical location.

What is a bedside swallow exam for dysphagia?

A bedside swallow exam is a test to see if you might have dysphagia. When you have dysphagia, you have trouble swallowing. Dysphagia can sometimes lead to serious problems.

When you swallow, food passes through your mouth and into a part of your throat called the pharynx. From there, it travels through a long tube called the esophagus. It then enters your stomach. This movement is made possible by a series of actions from your muscles in these areas. If you have dysphagia, the muscles don’t work properly. You may not be able to swallow normally.

When you breathe, air also enters your mouth and pharynx. From there, it travels to your lungs. Normally, a flap called the epiglottis blocks food particles and liquid from going into your lungs. If something does enter your lungs, it’s called aspiration. You are much more likely to aspirate if you have dysphagia. Aspiration is a serious problem. It can lead to pneumonia and other complications.

During a bedside swallow exam, your healthcare provider will assess your risk for dysphagia and aspiration. The test can be performed in your hospital room. It doesn’t need any special equipment. You will first be asked about your symptoms. You will also have a physical exam of the muscles used to swallow. You will then be tested on your ability to swallow different substances.

Why might I need a bedside swallow exam for dysphagia?

If you have dysphagia, aspiration is always a risk. So dysphagia needs to be identified quickly. Various health problems can lead to it. Some examples are:

Stroke

Major dental problems

Conditions that decrease saliva (such as Sjogren syndrome)

Mouth sores

Parkinson disease or other neurologic conditions

Muscular dystrophies

Blockage in the esophagus (such as from cancer)

You may need a bedside swallow exam if you are having any of the following symptoms:

Food sticking in your throat

Difficulty or pain while swallowing

Certain breathing problems

You may also need this exam if you have a medical condition that puts you at high risk for dysphagia. One example is if you have had a stroke. You may need the test even if you don’t have any symptoms of dysphagia. You may still be at risk for aspiration.

What are the risks for a bedside swallow exam for dysphagia?

A bedside swallow exam is safe. There is a slight risk that you might aspirate during it. This might lead to problems. But your speech-language pathologist (SLP) will try to prevent that.

The SLP typically begins the exam with the substances that are the easiest to swallow. He or she might stop at that part of the exam if you show signs of dysphagia and aspiration. If you have a very high risk of aspiration from dysphagia, you might not swallow anything as part of your exam.

Ask your healthcare provider if the exam presents any other risks for you. Follow-up tests to the exam may have risks, too.

How do I prepare for a bedside swallow exam for dysphagia?

You don’t need to do much to prepare for a bedside swallow exam. You might be told to not eat or drink anything beforehand. You may also want to make a list of your swallowing problems ahead of time. Then you can remember to share them with your SLP.

What happens during a bedside swallow exam for dysphagia?

An SLP most often performs the bedside swallow exam. The SLP checks for signs of dysphagia and aspiration throughout the exam.

First, your SLP may ask you questions about the following:

The nature of your swallowing problems, such as food sticking in your throat or pain while swallowing

The substances that usually cause these problems

Frequency, severity, and onset of these symptoms

Other symptoms that might be related to dysphagia, like heartburn or coughing when eating

Your medical history

If possible, the SLP may also talk with your family members. The SLP may ask them about what foods you find hard to swallow and what foods you tend to avoid.

During the exam, the SLP will carefully evaluate your teeth, lips, jaws, tongue, cheeks, and soft palate. You may need to perform certain movements, like smacking your lips together or sticking out your jaw. You may also need to make certain sounds, cough, or clear your throat. The SLP may check your reflexes for gagging and coughing.

You will likely be asked to swallow a series of substances. They may range from water, thicker liquids, pureed foods, soft foods, and even regular foods. The SLP will note whether you have problems chewing, swallowing, or breathing. He or she will also check if your voice sounds “wet.” That can be a sign of aspiration.

What happens after a bedside swallow exam for dysphagia?

Many people need to stay in the hospital after their bedside swallow exam. They usually need treatment for other medical problems. If you have the exam while visiting your healthcare provider, you will likely be able to go home right after it. You will usually find out about the results right away. If you don’t have any problems with swallowing, you may be able to eat normally again.

You may need follow-up tests if your medical team is still worried that you might have dysphagia. These tests can help identify dysphagia, even if you don’t have any symptoms. Sometimes they can also help pinpoint the source of a swallowing problem. These tests may include:

Modified barium swallow test (MBS) to visually show if material is traveling into your lungs

Fiberoptic endoscopic evaluation of swallowing (FEES) as an alternative to the MBS

Pharyngeal manometry to check the pressure inside your esophagus

You may need treatment if the bedside swallow exam or other tests show that you have dysphagia. In some cases, your medical team may be able to address what is causing your dysphagia. Surgery is one possible treatment.

Whatever the cause of your dysphagia, you will need to take precautions to prevent aspiration. You may need to modify your diet. For instance, you may need to drink only liquids of a certain consistency, or drink no liquids at all. You may also need to modify your position while you eat. You may learn special mouth exercises and techniques to help you swallow. If your swallowing is very poor, you may need to use a feeding tube for a short period of time.

How long it takes you to recover from dysphagia depends on its severity and cause. It’s important for you to work closely with your healthcare team for the best treatment. If you are moving to another facility or going home, follow your healthcare provider’s guidelines closely. They can help reduce your chance of aspiration and other medical problems. Only make changes to your diet after talking with your healthcare provider.